For some children, medical conditions can significantly impair their ability to receive adequate nutrition orally. In these cases, a gastrostomy tube, commonly known as a G-tube, offers a direct pathway for nutrition to reach the stomach. Surgically inserted through the abdomen, the G-tube ensures that children facing feeding challenges receive the necessary fluids and calories for healthy development.
A G-tube is placed by a surgeon during a procedure called a gastrostomy. The G-tube can remain in place for as long as a child needs it. Following the gastrostomy procedure, children can typically resume their normal activities once the surgical site has healed.
Who are Candidates for a G-Tube?
Children may require a G-tube for a variety of reasons, including:
- Congenital anomalies: Birth defects affecting the mouth, esophagus, stomach, or intestines.
- Sucking and swallowing disorders: These can arise from premature birth, injuries, developmental delays, or other underlying conditions.
- Failure to thrive: A condition characterized by a child’s inability to gain weight and grow at a normal rate.
- Difficulty with medication administration: Extreme cases where taking medicine orally is problematic.
Preparing for G-Tube Placement
Before a G-tube is placed, doctors often perform several tests to assess the child’s condition. An X-ray of the upper gastrointestinal (GI) system is the most common pre-operative test. This imaging technique allows the doctor to visualize the upper part of the digestive system.
Sometimes, the surgeon will request consultations with specialists such as a gastroenterologist, dietitian, or social worker. This collaborative approach ensures a comprehensive care plan is in place before the child goes home with the G-tube.
In preparation for the procedure, it’s vital to strictly adhere to the provided instructions regarding when to cease eating and drinking. Upon arrival at the hospital, the doctor will explain the procedure in detail and address any questions. The anesthesiology team will inquire about your child’s medical history and their last food and drink intake.
Prior to the procedure, the care team will connect monitors to track your child’s vital signs, such as blood pressure and oxygen levels, and insert an intravenous (IV) line for administering medications and anesthesia.
After these preparations, your child will be taken to the operating room while you wait in a designated area. A hospital staff member will update you once the procedure is complete.
The G-Tube Placement Procedure
There are three primary methods for G-tube insertion, sometimes used in combination:
- Laparoscopic technique: This involves making two small incisions in the abdomen. One incision is for inserting the G-tube, and the other is for a laparoscope, a tiny telescope that allows the surgeon to view the stomach and guide the G-tube into the correct position.
- Open surgery: This method utilizes larger incisions and is typically chosen when other methods are not suitable, such as in cases of scar tissue from previous surgeries or when the child requires additional surgery simultaneously.
- PEG procedure (percutaneous endoscopic gastrostomy): This procedure involves inserting an endoscope, a flexible tube with a camera and light, through the mouth and into the stomach to guide the G-tube into place.
Duration of G-Tube Placement
The G-tube placement procedure typically takes approximately 30 to 45 minutes.
Post-Operative Care Following G-Tube Placement
Children typically remain in the hospital for one to two days after G-tube placement. Many hospitals allow a parent to stay with their child during this time. Pain medication will be administered as needed.
Nurses will provide comprehensive training on:
- Proper care for the tube and surrounding skin to prevent infection.
- Management of potential problems, such as accidental tube dislodgement.
- Administration of feedings through the tube, including guidance on appropriate feeding formulas.
- Supporting independent eating, if approved by the doctor.
Prior to discharge, you should receive:
- Detailed instructions for home care, including bathing, dressing, physical activity, medication administration, and venting the tube to release gas.
- Scheduled visits with a home health care nurse to monitor progress.
- Follow-up appointments with your doctor to check the tube and your child’s weight.
Potential Risks Associated with G-Tube Placement
As with any surgical procedure, G-tube placement carries certain risks. The surgical team will discuss these risks with you before the procedure and take all necessary precautions to minimize them. It’s essential to address any concerns you may have before proceeding.
Potential complications may include:
- Formation of excess tissue (granulation tissue) at the tube site.
- Leakage around the tube.
- Problems related to anesthesia.
- Bleeding.
- Allergic reactions.
- Infection.
Granulation tissue or leakage can usually be managed with proper wound care or adjustments to the feeding schedule. In some cases, surgery may be necessary to address issues at the surgical site.
Parental Support After G-Tube Placement
It’s normal to feel apprehensive about the G-tube initially, but it’s crucial to become comfortable with its care. Here are some helpful tips:
- Always wash your hands thoroughly before handling the G-tube.
- Keep feeding set tubing away from infants and children to prevent accidental strangulation.
- Understand what to expect during the healing process. Contact your child’s care team with any questions.
- Seek support from other parents of children with G-tubes through support groups or online communities.
- Consult with a social worker to address any concerns your child may have about the tube’s appearance or potential reactions from others.
When to Contact the Doctor
Contact your doctor if your child experiences any of the following:
- A dislodged tube
- A blocked tube
- Signs of infection (redness, swelling, warmth, yellow/green discharge, fever)
- Excessive bleeding or drainage from the tube site
- Severe abdominal pain
- Persistent vomiting or diarrhea
- Difficulty passing gas or having bowel movements
- Protrusion of pink-red tissue around the tube
Early detection and treatment of problems can lead to quick resolution.
